May 5, 2020          By  David Stievater and Caitlin Abramson

Mainstreaming telehealth and virtual care

Commonwealth Health Advisors continues to analyze the lasting change that COVID-19 will have on the U.S. healthcare industry. Our perspective is informed by our collective years leading healthcare businesses as well as from working side by side with our customers. As a Boston-based healthcare management consulting firm, we are privileged to work with many established healthcare technology and services businesses, new entrants and disruptors, and financial and strategic investors. In Part 2 of our series, we take a deeper look at telehealth. How does one make sense of this new landscape? What should senior executives ask themselves to best position their organizations to win in a post-COVID-19 world?

Virtual care of all kinds is being rapidly adopted due to the pandemic. Right now, patients are seeing their doctors almost exclusively via telemedicine. There is a rush to figure out remote monitoring and virtual care for seniors. One behavioral health provider with which we are familiar saw its telepsychiatry visits increase by more than 8,000%–from 300 visits per week (1% of total visits)  in early March 2020 to 25,000 just three weeks later.

From its earliest origins, telehealth – the broader term encompassing telemedicine, remote patient monitoring and many other forms of virtual care provision – made only the smallest dent in patient and provider behavior. Prior to the pandemic, even with telemedicine availability among employer-sponsored health plans over 90%, utilization hovered at just 10%. Telehealth has always been a classic disruptive technology. Initially consumers viewed the quality of telehealth visits as inferior to the existing service (in this case, in-office visits) but eventually consumers (the patients) realize they have been “overserved” at a price that is high relative to their actual needs. Demand shifts to the better fit, lower-priced option.

There is no doubt that the COVID-19 crisis will permanently shift patient behavior towards the lower cost convenience of virtual visits. Furthermore, provider organizations which do not make this shift with their patients are in danger of being disintermediated, as they may lose patients to third-party telemedicine platforms and to providers who fully embrace the combination of in-person and virtual care.

We hope the following perspectives and questions raised help your organization frame your response to COVID-19, and the opportunities and challenges presented by telehealth.

Telehealth is rapidly becoming a welcome alternative care setting

The ‘forced’ adoption of telemedicine by consumers and providers across all specialties has brought this alternative care setting to the mainstream. Will the full relaxation of privacy rules and opening of ubiquitous technologies remain as is? Will all regulations and payment policies enabling the adoption during the “COVID Pause” become permanent? Will consumer preference shift to permanently prefer virtual care over traditional in-office settings? How will this vary by specialty? In addition to primary care, pediatrics, behavioral health, and chronic illness support/disease management, where else will telemedicine become central?

Reimbursement for Telehealth visits will continue to expand

Medicare is likely to continue to expand reimbursement for telehealth visits. How will reimbursement for this care evolve? What, if anything, will revert after the pandemic subsides? How will the reimbursement models adjust to permanently incent virtual visits? How will commercial insurers accommodate this? For which conditions?

Our ability to serve the senior population is dramatically improved

Remote Patient Monitoring (RPM) deployment will accelerate for seniors living with chronic illness. What role will CMS play beyond current reimbursement codes? Who will pay for this? Will there be a broader definition of what qualifies for reimbursement? Can RPM efforts simultaneously address isolation, loneliness and other social determinants? What are the enabling technologies / devices that will make this happen?

Providers face a surplus of choice regarding telehealth solutions

The many telehealth and telemedicine solutions options will present providers with near-term decisions most are not equipped to evaluate. Will the incumbent, large telehealth vendors win big in a post-COVID-19 environment? Or is there a role for new entrants? What is the danger of disintermediation for providers who don’t fully integrate telehealth into their traditional care setting? How tightly integrated with the EHR will solutions need to be? Can it work as a standalone?  How fast will the industry consolidate?

Behavioral health is primed to benefit from telehealth advances

Rapid expansion in behavioral telehealth will be driven by shortages of resources (psychiatrists and psychologists) coupled with growth in demand. Will telepsychiatry become a preferred play in the future of mental health? Who will lead this – traditional provider organizations or behavioral health specialists? What are the unique needs of behavioral health in designing telehealth solutions?

As healthcare executives consider the many questions that will surface during and after this pandemic, Commonwealth Health Advisors is working with companies to figure out the answers.  We look forward to the opportunity to apply critical thinking, strategic direction and actionable plans to organizations needing help re-imagining how this pandemic will affect their future, growth and profitability.